"The further a society drifts from the truth, the more it will hate those who speak it." Orwell

"Men are so simple of mind and so dominated by immediate needs that the deceitful man can easily find those ready to be deceived."
Machiavelli

"The demagogue is one who preaches doctrines he knows to be untrue to men he knows to be idiots.." H.L. Mencken

Friday, May 14, 2010

"Truly A Miracle"

So says Jerzy Buzek, head of the European Parliament. (There's a European Parliament? Who knew?) A plane goes down, killing everyone on board except a young boy, who has not yet been told that his mother, father, and brother are dead.

A miracle.

He'll grow up without his mom and dad, bearing survivors' guilt and God knows what else; in an instant, his life is changed for the horrible, forever.

A miracle.

A hundred people are dead, hundreds more grieving, kids without parents, parents without kids, futures erased by the stroke of an unseen hand. And a kid survives.

A miracle.

Because the god or gods that killed off a hundred, destroying hundreds more on the ricochet, decided not to kill one, but, rather, to leave his life in ruins, people see the hand of their deity and like what they see. But I wonder: which is the miracle, the killing or the saving, and why? God/gods must have been involved in each outcome, right? If he/she/it/they did the one, they most certainly did the other. If, as Ms Merriam Webster says, a miracle is "an extraordinary event manifesting divine intervention in human affairs," why is it the saving and not the killing? And what does it say about the god/gods who did it?

Well, that part is pretty obvious. What's not so obvious is why people find joy in it. I simply don't get it, and I can't imagine that I ever will. I do get why people need to put their eggs in a godly basket. I get that for most people, the capriciousness and finitude of life requires some sort of transcendent hedge. But coming up with an explanation that involves deeming such an event as this to be a miracle... who'd want to believe in such a higher power as that? Where's the comfort? Killing off a kid's family and breaking both his legs is a sign of deitific intervention? The deity they're down with? Yikes.

Their answer, I assume, is some variation of the basic theme: he/she/it/they work in mysterious ways. Giveth...taketh...blessed be... Which, really, is saying, simply, "Who the hell knows." With that, I'm quite okay: who the hell knows? And I wonder what the world would be like if everyone just accepted that truth, instead of their particular choice among all the disparate, internally and externally contradictory, hateful, destructive, rejectionist beliefs that seem to be destroying our planet and us. Accepting the uncertainty, what would it be if everyone settled on their own answers, let everyone else have theirs, and kept it all to themselves? Actually, I know what that would be:

Yes, there is a European Parliament and it is sad Americans don't know about it. It even gets elected by all European citizens every couple of years. True, it hasn't been too noticed yet but it is trying hard to gain influence.

What happened to this young boy is a tragedy. It has nothing to do with any diety nor does it have any greater meaning. A pure and horrible tragedy that will stay with him until the end of his life.

You maynot believe in God, Sid, but God believes in YOU:)LOL man, that saying used to piss me off...

I think the lone survivor kid will do just fine, children are pretty resiliant, besides, maybe he didn't like his Parents/Brother..I mean, I had an Uncle who drowned when I was 7, and I'm sure he was a great guy, but I never really missed him.

But you've got a point, if there IS a God/Jehova/Alla, why does he let really despicable evil people like the Ayatolla Khomeni, Fidel Castro, Jimmy Carter live to ripe old age, then slaps cute little 4 yr olds with his Leukemia Stick???

OK, your pretty smart knowin about the European Parliament, but I'll be more impressed if you can name a single hit from "Parliament/Funkadelic", no fair Googling.

Amazing might have been a better choice of words. I get it though ..that he survived it .. *seems* miraculous ..but ...I think it was also insensitive.

I've said and heard others .."Thank God he got better! Or God really protected us!" Some event that I felt the protection or help from God. I do believe he has helped, protected, etc.

BUT ... I try and I think people should try to be sensitive to their surroundings ..because just as you point out ..what about the people who God did not protect ...come in to help with divine intervention?

It is an imperfect world and extremely imperfect things happen.

It does not negate the existence of God ..nor does it mean he does not love the people affected by a tragedy .. pick your tragedy or calamity.

When people say it ..they don't mean to negate the bad and I can't speak for the person.. but I am guessing he just focused on how the boy was not killed ..that he was the lone survivor. But just as you were offended ..how did the surviving family members feel to hear that? Did God not love the others?

Right now ..My closest friend in life since I was 4 and she was 5 (friends 51 yrs this coming June), like a sister ..we are both only children ..we are so close that when we talk ..we will laugh or sigh at the same time when talking, we get each other without even having to utter a word. It's like she is part of me.

This week she was told she probably has the rare lung CA that nonsmoking women get. She has a r pleural effusion ..now coming back after last week's thoracentesis. She was told and shown today that she has a tumor in her r lung (not small like a nodule she said), pressing against her left lung and her r lung is partially collapsed. He told her the cancer metastasized. The CT order read as malignant cells consistent with adenocarcinoma.

He never mentioned stage to her which is a good thing ..but I assume she will know soon after her first oncology consult Monday afternoon. He may do a biopsy if the oncologist recommends it, but doesn't want to put her through it. He said he will do another thoracentesis soon when she is ready.

I am scared because she has also told me her spine is stiff, her bowels don't hurt but feel twisted, she can't lie on her right side, she has sob easily and now today ..she is having a pain under her left breast. She has always been an anxious person and I am afraid will shut down when she puts it all together, is told or does her own research.

All her life - she ate healthy most of the time, exercised, never smoked, never took even a tylenol unless sparingly ..oh and not on any meds because she always has perfect blood work and no htn!

It sure as heck does not seem fair!! WHERE is GOD? She IS a CHRISTIAN and neither of us understand! But because we don't understand or because bad things happen ..does not mean God does not care or exist. there are things we may never understand.. because we can't see the big picture... horrific things. This feels horrific to us and her family. hearing the fear ..knowing she is near phobic about vomiting and would rather lose her hair than vomit ....this does NOT seem FAIR!

And I scared myself and looked up info and if I read correctly ..it is stage IV. When I read what lung ca pts go through as it progresses I could've vomited. I am so scared and get intermittent darts of dread and gripping heaviness in the center of my being and obviously it is much worse for her. Where IS God??! I read the prognosis stats for non sm cell carcinoma. I thought that might be it ..but she doesn't have the final word yet..I am guessing.

I will be with her ..getting her to appointments, staying with her whenever so she is not alone. I will be there as much as she wants or needs ..and I am scared ..and feel sick about it and my heart is breaking for her as I hear her try to understand ..yet avoid ..her innocence in seeking reassurance. And we have ALWAYS been able to talk nonstop ..forever and our husbands know that when we get together ..no matter what time we say we will be home ..it will really be 2 or 3 in the morning. But now ..talking ..for me ..talking is like navigating through a verbal minefield and walking a tightrope. Conversations as we knew it ..seemed to have come to a halt... stilted... stumbling and I have a whole other dialog in my head from the words I speak to her.

But HOPE and FAITH ... we are NOT giving up! We may not understand ..we may feel abandoned by God ..but that is where faith kicks in.

We are praying for the miracle. But no matter what ..God still loves her. And he still loves everyone worried about her. Faith is believing in things unseen.

Well Eugene ..it looks like you called the 20 paragraphs right. You should've gotten a pool going. :)

I'm sorry about your friend, Seaspray. When the doc told her it had metastasized, he defined stage four.

I hate to get argumentative when you're dealing with your friend's illness, but since you came into this thread, I feel like making the point that when people look at all the tragedies of the world, large and small, and conclude their god loves us all, to me it's the same as saying he/she/it/they don't.

Because what's the difference? No matter what happens, deity loves us. That's not really any sort of philosophy. If there's only one answer to everything, then there's really no answer of significance, and it simply confirms my argument: we believe because we can't stand not to.

So no belief is any better than or different from any other. It's all to do the same thing: wipe away doubts and fears, prevent the struggle of ideas, doing the hard stuff.

Which, of course, gets us back to the central theme of this blog: we've become a nation of easy answers, which are no answers. Your idol Sarah is the perfect example: she just said our laws should be the laws of the Bible. So easy. So irrelevant to facts. All we have to do is love deity and everything will be all right.

There are no problems, no hard questions with which to wrestle. Liberals are the problem, the media are liberal, Obama's a Nazisocialistmuslimamericahater. So easy.

It's one thing to use such thinking to get oneself through life, and through the pain of watching loved ones die. Fine with me. It's quite another when it becomes the political philosophy of an entire party and its house organ.

Really, THAT'S my problem with religion. As a substitute for facing reality, when it becomes politics, it's dangerous and empty. If people would find their solace and then keep it to themselves, it would be absolutely fine with me and I'd shut up about it. But as long as there's Sarah Palin and Fox "news" I'm afraid I can't.

You are the only medical person who has come out and told me it is stage IV. Even my dear pcp would not tell me what stage he thought... he avoided yesterday. I don't want avoidance or sugar coating ..I am trying to quietly gear up and possibly be a jump ahead of any info she will give me.

Can this ..barring a *miracle* go into remission? Shouldn't they take the tumor out? Or does chemo shrink it and then remission?

And does a lung tumor define it as lung CA, but then metastasis to other organs, etc.. is that still considered lung ca?

And so when they use the cancer specific drugs ..is it designed for only lung CA? because other affected sites are because of the lung ca?

And does chemo in the system ..kill off the cancer through out the body and is that what remission is? Then radiation gives it the double whammy?

Yet ..some people look for quality vs quantity of life and refuse treatment. I guess that depends on how beatable the ca is. ??

I did read that with lung ca - radiation doesn't cure ..but is is good for palliative treatment of progressing symptoms. is that true.

it is difficult for this non medically expertised brain to differentiate applicable facts from misguided.

We are going to church tonight and she will be anointed with oil and prayed over after the service. We do believe in the possibility of divine healing.

But ..as I said ..I am quietly gearing up for navigating through unknown and frightening territory and I figure being armed with some facts will be my strength for things to be faced and effectively help her and the whole thing is gonna hurt and be hard no matter where this leads.

And I really am wondering about the time frame... which I guess ..only God can really know.

But no matter what ..I am still holding out in FAITH for HOPE and a MIRACLE.

And still want the real facts or be directed to a good medical site that will explain. If you or any of your readers could do that I would me so grateful! Thank you.

I wrote an answer to your other comments and could not BELIEVE my computer shut down after an update and lost everything and so I will come back to it when I have a chance.

It sounds like the exact cell type might not yet be known, but draining the fluid should give the answer. In any case, lung cancer is lung cancer wherever it ends up: bone, liver, etc. Still lung cancer, and the cells will respond (or not) to treatment wherever they are the way the type of lung cancer does.

Once a cancer has spread, there often is little or nothing to be gained by removing it from the primary site, unless it's about to cause a problem, like obstruction of something.

What type of chemo to use, if any, will depend on the exact cell type. Radiation, when it's metastatic, is usually only done to alleviate a symptom, like pain or obstruction in a specific location.

Stage IV lung cancer is considered incurable, no matter the cell type. Some types respond temporarily to treatment.

Doctors can give a range of expected time, based on data from similar cases.

We are all so frustrated at how long it takes to get the treatment going. After monday's oncology meeting she had an abd/pelvic ct today, tomorrow a brain MRI and Monday a bone scan.

She had a thoracentesis monday and again 2 liters of fluid removed... AGAIN. Doctor doesn't want to do surgery to seal leak, mentioned maybe talc, but seems to be pushing a tube draining fluid into bag. (what do they call that?) She is more sore after 2nd thoracentesis Monday ..but really wants to swim this summer and she won't be able to with that. Although she is very tired and thinks the stress is getting to her ..although her first symptom was tiredness and then the pleural effusion in March.

I just don't understand why if they know the type of ca ..why not give her the chemo to target it? even tho she has to get other tests?. It's already 2 weeks since last thoracentesis.

Isn't *TIME* of the essence??? To target and obliterate the active ca process? They told her not curable but they want to suppress it. If she has a certain receptor she may be a candidate for a certain treatment and the fact that she was healthy and took care of herself is in her favor. I hear her inhaling air through her nose while talking to get her breath and she said when she bends over she feels pressure in her throat. Her voice has been getting hoarse.

Why don't they make these tests happen right away and get started? DOES treatment time matter ..when they start?

It is extremely frustrating. She can't even get 2nd opinion until all info together. You'd think they would say get all these tests before oncology appointment so they have facts and are ready to go ..assuming these are standard tessts. And ..I thought PET scans were the most accurate tests. Why not order a PET scan?

She has a low grade temp.

Dr S ..I guess the bottom line to all of the above ... is this normal? Does the process to get started with chemo treatments take this long ...normally?

With a 3b ca now she won't be getting started until sometime next week (THREE weeks or more!)if they wait for the bone scan.

Needless to say she is terrified of the process of what is going on in her body and just wants to target it with the treatments...and get other opinions.

This waiting just seems so wrong. You'd think they would get moving and make things happen with ca patients. Of course there are many patients and so maybe scheduling is the problem ..but it just doesn't seem right.

I don't think I have much to add, Seaspray. Your questions are good ones, but I just don't have the info to answer them. I don't know much about current status of chemo for adeno ca of the lung or, for that matter, staging as it relates to treatment.

As to timing, waiting three weeks, I doubt it'd be significant other than driving everyone crazy, but she ought to ask her docs.

Thanks Dr S - Her oncologist gave her ..her cell number which I think is very compassionate and I also think indicates she would want her to call with a concern (probably when things are more difficult), but also tells me she welcomes questions and I wish my friend would just ask her. her family, friend and myself are anxiously waiting when perhaps the doc could explain and we'd all relax ..especially my friend. I think it is perfectly fine to call the office and have the question relayed to the doc ..but my friend doesn't want to bother anyone. But doctors aren't mind readers and you would hope they would cover all the bases, but that doesn't always happen.

I do have a surgical question.

Why do tumors ..hers anyone's become inoperable. Isn't that what surgeons do? they have years of training and then practice learning how to cut things out? Is it that the tumor has intricately woven itself into other tissue and to remove would cause greater damage? or is it because if metastasized it is too late from the ca standpoint and so why add additional suffering when it won't matter?

But Dr S ..it seems to me ..if treatment can't control the tumor ..as in her case ..it will grow ..affect her breathing and give all kinds of problems. Why can't they just take it down in size without removing it? Oh and this is for my own understanding ..not shared with friend or family. I would NOT do that.

I mean ..I KNOW if they won't operate ..thre is a reason but it just seems ..that in this day and age ..you would think a surgeon coyuld find a way around this.

ESPECIALLY ..because right now ...RIGHT NOW ..her labs and health otherwise is perfect. She never had any htn,dm,lipid profile always good...never needed meds, exercised, ate well most of the time..never smoked (I could go on), but my point is that even the oncologist said it is good that she has been so healthy (in her favor) and so I am wondering ..well than THIS would be the time to operate ..while she is strong and healthy in other ways besides this disease. her breathing is compromised and she has the symptoms I described ..but darn ..if they remove the tumor ..even if not the cancer in system ..she may not have the awful things that may happen with a growing tumor?

I don't even mean specifically her ..but generally ..as a surgeon ..what does inoperable mean to you? WHY do you deem something inoperable?

***And do you have anything in your surgeonsblog I might want to read on the subject overall?

btw - here is a post for that blog.

The difference between operable and inoperable for a surgeon. ? then ..why do some surgeons ..well on Grey's Anatomy they do ..forge ahead and operate against the consensus among their peers?

The waiting is horrible!

I have to say ..that when we went to church..was the first time I saw her since getting the news and I kept looking at her ..trying to process the reality of this and she looks so healthy. She looks so healthy that I keep thinking they had to have made a mistake! Except ..I notice the mild sob with exertion or a lot of talking.

There's confusion between numerical stages, and alphabetic ones sometimes; usually A,B,C applies to colon ca, where B is pretty much the same as stage II. Under most circumstances, stage B or II would be considered operable, assuming the patient's general health allowed it. Inoperable, as you suggested, usually means either you can't get it out because it's wrapped around or grown into something vital in such a way that removing it is technically impossible or highly dangerous. That's pretty much by definition at least stage III or C.

And when the tumor itself is removable but has spread widely such that death is assumed before the primary tumor would cause problems, or when chemo is known to be ineffective for the distant mets, those are reasons not to operate if the primary is asymptomatic

She said adenocarcinoma stage 3b and so I looked it up and I thought I read that with this type of lung ca it meant inoperable.

Her pulmonologist doesn't even want to go in and repair the tear that is causing the pleural effusion... or use talc. (not sure what I am talking about there other than it seals it)

To me ..that means ..since she is strong and healthy or had been ..he sees a futility ..perhaps because of the inoperable tumor and perhaps because metastasized.

My concern ..great concern is that if they don't shrink this tumor down, the discomfort with breathing, etc will exacerbate ..which I realize may happen anyway... but the longer they tale the more opportunity for the cancer.

This afternoon she told me it hurts to breathe and she has new pains across her pack ..small new ones.

This is a woman who not only was fit ..but fortunately ..never even had pain in her body ..except this year her feet were aching a bit.

For The Sake of My Sanity

Some will know me from my other blog, "Surgeonsblog." Of late I've given over to frothing at the mouth as the world descends into stupidity, and our politics and our citizens seem, in numbers enough to be meaningful, unable to see it. So for now I'm leaving surgery writing behind, if for no other reason than to defuse and diffuse my unrelenting sense of doom, and with no expectation of making a difference. These are things that, to me, are obvious. Except that, apparently, they aren't.

RWS™

RWS™: For those who drop by here in the middle, and wonder what it means: it's my shorthand for Right Wing Screamers, which includes such a long list it's tiresome to type it. (I distinguish these blowhards from thoughtful conservatives, of whom I sort of take it on faith that there must still be some.) You know who I mean: Palin, Beck, O'Reilly, Limbaugh, Hannity, Coulter, Breitbart (RIP), Malkin, Savage, Levin, Ingraham, Doocey (more of a drooler than a screamer), Hewitt, Goldberg, Gingrich, Kristol, Scarborough (+/-), Bachmann, Inhofe, Bond, Broun, Boehner, Kelley, Santorum, Cain. To name but a few. Behold them in their unrepentant disregard for reality: the RWS™